WHEC Update - September 2007

Global inter-connectedness and rapidly advancing technology have spawned a whole new set of challenges and opportunities, without closing the book on the old. It is not a bad thing to be strong in some ways and fragile and vulnerable in others. There are times you hold the future in your hands. And times you trust the future to others. At some point, you realize the legacy you leave goes far beyond the financial. For you, true wealth is about helping people. It is about achieving life. In every country (and in many sub-national structures such as states and provinces), health economics plays, or should play, an important role in critical policy and operational decisions. Poverty is not new, but there are creative new strategies for addressing it. Can we work together now? I think we can. WomensHealthSection.com is a global, Web-enabled platform for multiple forms of collaborations. We invite you to tap into this platform, and finally, the governance to get the best out of this platform. With each issue of WHEC Update, we like to think we are taking our readers on a journey. Clear boundaries lead to empowerment. Empowerment is not magic. It consists of a few simple steps and a lot of persistence. One other thing: In this space we have continued to update you on our e-learning project WomensHealthSection.com. The connection between education and health has never been clearer. We bring you every month -- Briefings -- of various programs / projects of the UN System, exclusive interviews, online polls and more fresh surprises. The UN role in ensuring peace and security and in shaping globalization to the advantage of all people in the world has been growing. Now more than ever before, dealing with inequality and achieving the Millennium Development Goals (MDGs) and wider development objectives are central to global economic stability and prosperity. Decisions help us start -- discipline helps us finish. The journey is the reward. You might want to fasten your seat belts.

Combating maternal mortality / morbidity is a collective effort. Obstetrical fistula is a problem that can be prevented, treated and controlled. For those who are grappling with the disability, effective treatment is essential. It requires political leadership and sufficient resources -- particularly for more and better birthing centers, close to their homes and close to their birthing cultures. It requires the engagement of family members and community leaders as well as health care and social workers. It requires the media and policy makers to play their part. It means reaching out to marginalized groups and ensuring they receive the care they need with healthy and happy pregnancy and childbirth. That means providing reasons to hope. Obstetrical fistula brings anguish and torment to individuals and their loved ones. It eats away at the fabric of the human being, of the family, of society. It is a subject all of us must take personally. Let us ensure there is no place for obstetrical fistula in modern obstetrics. We welcome the thoughts and suggestions on eradication of obstetrical fistulae. WomensHealthSection.com enables individuals, groups, companies, and universities anywhere in the world to collaborate -- for the purposes of innovation, education, research and to advance the causes of peace, health and development. We welcome everyone.

Campaigning to End Fistula
Rita Luthra, MD

Your Questions, Our Reply:

What are the good practices in terms of shaping a foreign policy that can work to improve global health? How can foreign policy address new infectious diseases in an age of globalization and bio-terrorism?

Foreign Policy and Global Health Diplomacy: the rise of health as a foreign policy concern has become a hallmark of a globalized world. Critical to global health diplomacy is the relationship between health and foreign policy. The trade and health relationship unfolds on the cutting edge of global health diplomacy and offers lessons for the health and foreign policy nexus. We need broad memberships between rich and poor countries to improve health. And rich countries need to help developing countries to make a dedicated effort with their health budget allocation. Health also belongs in the Security Council and more prominently at the World Bank. It is important to have trade agreements that do not complicate access to drugs at affordable prices, patent regulations and other trade regulations, so that poor countries have access.

The cutting edge of global health diplomacy raises certain cautions regarding health's role in trade and foreign policies. Competition among countries' national interests sometimes impedes policy coherence, which makes attainment of health difficult. To craft health policy today, governments, international institutions and non-governmental organizations (NGOs) must find mechanisms to manage health risks that spill into and out of every country. These endeavors create the new world of global health diplomacy. Health is a bridge builder and a key component of the development policy. The nexus of security, insecurity and health must take center stage in foreign policy thinking.

To achieve global governance, we believe, a new global health forum is needed to address health. We believe capacity building is vital to health system development and is also needed to stabilize countries in order to provide security for people so they do not feel the need to migrate.

About NGO Association with the UN:

Chairpersons of UN Committees and their views on various issues:

Hamid al Bayati, the Permanent Representative of Iraq to the United Nations, was elected chairman of the Third Committee (Social, Humanitarian and Cultural) of the sixty-first General Assembly on 8 June. His reply to some of questions on the agenda of Third Committee:

Human rights issues have become central to the Third Committee. One of the newest additions to the UN human rights framework is the Human Rights Council. How do you think the delegates perceive the early work of the Human Rights Council?
I think people were excited to have the Human Rights Council, which is based in Geneva, for the first time. It gives the Third Committee a special importance this year. There was some debate among member states about whether the report of the Council should be referred to the Plenary or to the Third Committee. According to the rules of procedure, a subject should be referred to the committee that deals with that subject, and so we finally agreed to convey to the General Assembly - and the General Assembly approved this - that the report should be referred to both the Third Committee and the Plenary. The Plenary discusses the annual report, while the Third Committee deals with all of the Human Rights Council's recommendations.

Is it difficult for you when issues regarding your home country of Iraq are discussed at the Third Committee?
There was only one occasion when I felt I couldn't chair the Committee because of criticism that was being made of my country. While Iraq is open to criticism, I didn't feel it was fair for me to listen to criticism without replying. So in that instance I instead let my delegation reply from Iraq's seat. Other than that occasion, I didn't have any difficulties listening to people talk about the situation in Iraq. In regards to human rights, in fact, Iraq - whose record is not perfect in this area - is making strides. We now have a ministry for human rights in Iraq for the first time in modern history.

What was the hardest thing about chairing this Committee? What was the most rewarding?
The most rewarding feeling is to be serving Member States, and to be doing even a little bit to protect human rights. When you feel that you are providing assistance to the most vulnerable people - especially women and children - this is very rewarding. The most difficult thing is to come to a compromise. Member States are always ready to vote, but for a Chair a vote means you have failed to convince delegates to meet in the middle. I always tried to be neutral, I always tried to be transparent in my actions, and I always tried to put myself in the shoes of both sides. The best ways is to meet in the middle, but it is a difficult thing to always suggest the right kind of compromise.

Collaboration with World Health Organization (WHO):

Obstetric fistula: surviving with dignity -- An obstetric fistula is a devastating yet often neglected injury that occurs as a result of prolonged or obstructed labor (usually resulting in a stillbirth as well). Trauma to the vaginal wall results in an opening between the vagina and the bladder, the vagina and the rectum, or both; this leaves the woman leaking urine and/or feces continuously from the vagina. Without surgical repair, the physical consequences of fistula are severe, and include vaginal incontinence, a fetid odor, frequent pelvic and/or urinary infections, pain, infertility and often early mortality. The social consequences of fistula are immense: women with fistula are ostracized and frequently abandoned by their husbands, families and communities; they often become destitute and must struggle to survive. To make matters worse, many women are so embarrassed by this condition that they suffer in silence, rather than seek medical help, even if such help were available. This devastating condition affects more than two million women worldwide. There are an estimated 50 000 to 100 000 additional cases each year, a figure some believe to be an underestimate. Most are young women or adolescents. Early marriage, early or repeated childbearing, along with poverty and lack of access to quality health care in pregnancy and at birth, are the main determinants. Fistulae occur in areas where access to care at childbirth is limited, or of poor quality, mainly in sub-Saharan Africa and parts of southern Asia. In the areas where fistulae are most often seen, few hospitals offer the necessary corrective surgery, which is not profitable and for which surgeons and nurses are often poorly trained. In 2003, the United Nations Population Fund along with WHO and other partners launched a Global Campaign for the Elimination of Fistula. Good-quality first-level and back-up care at childbirth prevents fistula. Once the condition has occurred it is treatable. The plight of women living with fistula is a powerful reminder that programmatic concerns should go beyond simply preventing maternal deaths. Decision-makers and professionals should be aware that the problem is not infrequent, that the girls and women who suffer from it need support to get access to treatment, that enough trained doctors and nurses need to be available to provide surgical repair, and that further support is necessary for women who return home after treatment. Collective action can eliminate fistula and ensure that girls and women who suffer this devastating condition are treated so that they can live in dignity. Details: http://www.who.int/whr/2005/chap4-en.pdf

Bulletin of the World Health Organization; Volume 85, Number 9, September 2007, 649-732 Table of contents

Collaboration with UN University (UNU):

The United Nations University Institute of Advanced Studies (UNU-IAS), the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the United Nations University Office at the United Nations in New York (UNU-ONY), are jointly organizing a side event within the framework of the Eighth Meeting of the United Nations Open-Ended Informal Consultative Process on the Oceans and the Law of the Sea (UNICPOLOS).

Marine Genetic Resources: In 1999, the General Assembly decided to establish the United Nations Open-ended Informal Consultative Process on Oceans and the Law of the Sea (the Consultative Process) in order to facilitate the annual review by the General Assembly, in an effective and constructive manner, of developments in ocean affairs and the law of the sea by considering the report of the Secretary-General on oceans and the law of the sea and by suggesting particular issues to be considered by it, with an emphasis on identifying areas where coordination and cooperation at the intergovernmental and inter-agency levels should be enhanced (resolution 54/33). The Eighth meeting of the Consultative Process will organize its discussions around the topic of "Marine genetic resources," as recommended by the General Assembly in resolution 61/222. Oceans are experiencing rapid and, in many cases, dramatic changes as a result of human activity. Because the world's oceans remain a source of livelihood for hundreds of millions of people, their sustainable and equitable use must continue to be promoted. The growing commercial interest in deep seabed research and the use of the unique genetic resources that this research has discovered raises key policy, ethical and moral questions. Therefore, the meeting will focus on five important issues related to marine genetic resources, with the aim to bring some additional information and experts' insights to the Eighth Meeting of the Consultative Process.

Scientific aspects of marine genetic resources: status of scientific research and changes in scientists' perspectives;

Commercial uses of marine genetic resources;

Potential values of marine genetic resources;

Development of a database on marine bio-prospecting;

Next steps needed to be taken.

Joint United Nations Program on HIV/AIDS (UNAIDS):

Support and encourage the development of national and international research infrastructure, laboratory capacity, improved surveillance systems, data collection, processing and dissemination, and training of basic and clinical researchers, social scientists, health-care providers and technicians, with a focus on the countries most affected by HIV/AIDS, particularly developing countries and those countries experiencing or at risk of rapid expansion of the epidemic;

Strengthen international and regional cooperation in particular North/South, South/South and triangular cooperation, related to transfer of relevant technologies, suitable to the environment in prevention and care of HIV/AIDS, the exchange of experiences and best practices, researchers and research findings and strengthen the role of UNAIDS in this process. In this context, encourage that the end results of these cooperative research findings and technologies be owned by all parties to the research, reflecting their relevant contribution and dependent upon their providing legal protection to such findings; and affirm that all such research should be free from bias;

By 2003, ensure that all research protocols for the investigation of HIV-related treatment including anti-retroviral therapies and vaccines based on international guidelines and best practices are evaluated by independent committees of ethics, in which persons living with HIV/AIDS and caregivers for anti-retroviral therapy participate;

HIV/AIDS in conflict and disaster affected regions
Conflicts and disasters contribute to the spread of HIV/AIDS

By 2003, develop and begin to implement national strategies that incorporate HIV/AIDS awareness, prevention, care and treatment elements into programs or actions that respond to emergency situations, recognizing that populations destabilized by armed conflict, humanitarian emergencies and natural disasters, including refugees, internally displaced persons and in particular, women and children, are at increased risk of exposure to HIV infection; and, where appropriate, factor HIV/AIDS components into international assistance programs;

Call on all United Nations agencies, regional and international organizations, as well as non-governmental organizations involved with the provision and delivery of international assistance to countries and regions affected by conflicts, humanitarian crises or natural disasters, to incorporate as a matter of urgency HIV/AIDS prevention, care and awareness elements into their plans and programs and provide HIV/AIDS awareness and training to their personnel;

By 2003, have in place national strategies to address the spread of HIV among national uniformed services, where this is required, including armed forces and civil defense force and consider ways of using personnel from these services who are educated and trained in HIV/AIDS awareness and prevention to assist with HIV/ AIDS awareness and prevention activities including participation in emergency, humanitarian, disaster relief and rehabilitation assistance;

By 2003, ensure the inclusion of HIV/AIDS awareness and training, including a gender component, into guidelines designed for use by defense personnel and other personnel involved in international peacekeeping operations while also continuing with ongoing education and prevention efforts, including pre-deployment orientation, for these personnel;

Resources
The HIV/AIDS challenge cannot be met without new, additional and sustained resources

Ensure that the resources provided for the global response to address HIV/AIDS are substantial, sustained and geared towards achieving results;

By 2005, through a series of incremental steps, reach an overall target of annual expenditure on the epidemic of between US$ 7 billion and US$ 10 billion in low and middle-income countries and those countries experiencing or at risk of experiencing rapid expansion for prevention, care, treatment, support and mitigation of the impact of HIV/AIDS, and take measures to ensure that needed resources are made available, particularly from donor countries and also from national budgets, bearing in mind that resources of the most affected countries are seriously limited;

To be continued...

Top Two Articles Accessed in August 2007:

The Obstetrical Fistulae in the Developing World;WHEC Publication. Special thanks to WHO, ICM and FIGO for its program/project -- Making Pregnancy Safer, and the United Nations Population Fund for their efforts and contributions. It is our privilege to work with this humanitarian project/program.

News, Invitations and Letters:

THE SECRETARY-GENERAL MESSAGE ON THE INTERNATIONAL DAY IN SUPPORT OF VICTIMS OF TORTURE: This is also the first year that the International Convention for the Protection of All Persons from Enforced Disappearance -- another milestone in the struggle to eliminate torture -- has been open for signature. I hope that all UN Member States will sign and ratify this convention as early as possible. Joining this new instrument will prove an unequivocal expression of the international community's determination to address not only torture but also its most egregious enabling conditions. As we join hands against torture, and adhere unequivocally to the notion that torture is unacceptable, we must never forget its victims. The United Nations Voluntary Fund for Victims of Torture supports organizations assisting victims of torture and their families. Let me use this occasion to thank all donors to the Fund, and to encourage even more giving to this worthy cause. On this International Day in Support of Victims of Torture let us speak with one voice against the perpetrators of torture, and for all who suffer at their hands. And let us build a better, more humane world for all people everywhere.

Informal Interactive Hearing with Civil Society, including Non-Governmental Organizations and the Private Sector of the High-level Dialogue of the General Assembly on Inter-religious and Intercultural Understanding and Cooperation for Peace: The General Assembly, in its resolution 61/221 of 20 December 2006, (OP. 14) decided "to convene in 2007 a high-level dialogue on inter-religious and intercultural cooperation for the promotion of tolerance, understanding and universal respect on matters of freedom of religion or belief and cultural diversity, in coordination with other similar initiatives in this area". In its resolution 61/269 of 25 May 2007, the General Assembly further decided that the High-level Dialogue would be held on Thursday and Friday, 4 and 5 October 2007 at the ministerial or highest possible level, and that it shall consist of three plenary meetings: one in the morning of Thursday, 4 October and two on Friday, 5 October. The General Assembly also decided to hold in the afternoon of 4 October 2007 an informal interactive hearing with representatives of civil society, including representatives of non-governmental organizations and the private sector, to be chaired by the President of the General Assembly. The Office of the President of the General Assembly has formed a 'Task Force' to help ensure the effective participation of civil society, including non-governmental organizations and the private sector, in the interactive hearing. The function of the Task Force is to assist the President of the General Assembly in the organization of the hearing by recommending formats and by drawing up a list of participants. A complete list of Task Force Members, Advisers and Ex-Officio can be accessed on the website of the President of the General Assembly: http://www.un.org/ga/president/61/

The United Nations and Darfur:

More than 200,000 people are estimated to have been killed and at least 2 million displaced from their homes in Darfur since fighting broke out in 2003 between Government of Sudan forces, allied Janjaweed militia and other armed rebel groups. Atrocities such as the murder of civilians and the rape of women and girls have been widespread and continue, underscoring the necessity for urgent action. The UN raised the alarm on the crisis in Darfur in 2003 and finding a lasting resolution has been a top priority for the Security Council and two consecutive Secretaries-General. In addition to pursuing a political solution, the UN and its partners are currently operating the largest aid effort in the world in Darfur and in refugee camps in Chad and the Central African Republic (CAR). In parallel, UN human rights experts have reported on abuses, and monitored efforts by local courts to bring perpetrators to justice. Under the auspices of the African Union (AU) and with support of the UN and other partners, the Darfur Peace Agreement (DPA) was signed on 5 May 2006. Intensive diplomatic and political efforts to bring the non-signatories into the peace process continue. The UN has also provided logistical and technical assistance to AU monitors dispatched to Darfur since 2004, and has developed, adapted and is now implementing plans for a multidimensional peacekeeping operation. In accordance with the decision of the 16 November 2006 High-Level consultations in Addis Ababa — attended by the former Secretary-General, five Permanent Members of the Security Council, representatives of the Government of Sudan, the AU and other States and organizations with political influence in the region, and some African Union Mission in Sudan (AMIS) troop contributing countries — the UN Department of Peacekeeping Operations (DPKO) designed a three-phased approach to augment AMIS and create an unprecedented hybrid AU-UN peacekeeping force. Intensive private and public diplomacy by Secretary-General Ban Ki-moon and several actors in the international community resulted in Sudan's acceptance of this force in June 2007.

Humanitarian efforts -- UN humanitarian agencies are leading the largest current relief effort in the world to assist the approximately 4.2 million people in need of aid due to the Darfur crisis. Of these, 2.1 million are internally displaced in Sudan, while approximately 236,000 are refugees in eastern Chad. More than US $650 million in aid to Darfur is planned for 2007. More than 12,000 humanitarian workers are deployed in the region to bring assistance to those affected by the crisis. They include staff from 13 UN agencies, the Red Cross/Red Crescent societies and more than 80 non-governmental organizations (NGO). Over the last four years, this massive humanitarian effort has saved hundreds of thousands of lives. Mortality rates have been brought below emergency levels; global malnutrition has been halved from the height of the crisis in mid-2004; and nearly three-quarters of all Darfurians now have access to safe drinking water. However, civilians continue to be forcibly displaced as a result of attacks from all sides, with more than 140,000 displaced in Darfur in the first five months of 2007 alone. With populations growing, many IDP camps can no longer absorb new arrivals, and tensions are rising. The humanitarian operation and its staff have been increasingly targeted by violence. As of June 2007, 69 aid workers had been temporarily abducted, 37 convoys had been attacked or looted, and 61 humanitarian vehicles had been hijacked. Some leading NGOs have withdrawn citing violence against aid workers. The UN estimates that more than half a million people across Darfur are currently cut off from humanitarian assistance. This is an improvement in access since February 2007, when 900,000 were inaccessible, and is attributed to increased efforts by humanitarian workers to reach conflict-affected populations through innovative and often expensive means — not to any improvement in the security. The UN has continued to press the authorities in Khartoum for improved humanitarian access and security for aid workers, resulting in the signing in April 2007 of a joint communiqué between the Government of Sudan and the UN to effectively ensure and facilitate humanitarian activities in Darfur. Donors have funded 62% of the Darfur aid operation (as of 15 June 2007, US $396 million had been pledged or committed out of the US $652 million required), mostly for food aid. Other sectors are seriously under funded and require commitments. In the face of continuing insecurity, the UN and its humanitarian partners are effectively holding the line for the survival and protection of millions.

International Criminal Court - Following a recommendation by the Commission of Inquiry, in March 2005, the Security Council, in resolution 1593, referred the situation in Darfur to the International Criminal Court (ICC) and ordered Sudan to cooperate with the Court's investigations. On 2 May 2007, the ICC issued arrest warrants for crimes against humanity and war crimes against former Minister of State for the Interior of the Government of Sudan and current Minister of State for Humanitarian Affairs, Ahmad Harun, and Janajweed commander Ali Muhammad Ali Abd-Al-Rahman.

Special Thanks:

WHEC thanks Mr. Juan-Carlos Brandt, Chief, NGO Section, Department of Public Information, United Nations for his friendship and support to our efforts to improve maternal and child health worldwide. Thanks for the friendship. It is indeed our privilege to work with you and the entire department.

Beyond the numbers...

Happy the man, whose wish and care
A few paternal acres bound,
Content to breathe his native air
In his own ground.